Valence Health Eases Clinical Integration Pains with Analytics
Commentary by Todd Stockard, Cofounder, Senior Vice President,
Financial and Data Management Services,
Valence Health
When Valence Health cofounder Todd
Stockard left the benefits and actuarial
group of a large consulting firm more than
a decade ago, he left on a mission. Along
with cofounder Phil Kamp, his aim was to
help groups of independent doctors and
hospitals leverage the economies of scale
that come from clinical integration without
the burden of sharing a common healthcare
information platform. To do this, they
used business analytics to develop a set
of analytical and information delivery tools
and services that deliver patient-centered,
data-focused support—helping doctors and
hospitals manage risk, achieve financial
success, and deliver a higher quality of
healthcare services to the population.
Nearly 15 years later, with a staff of 120,
Valence Health is a turn-key HMO administering
the financial, actuarial, data analysis,
claims payments, customer service, and
medical management of many provider-sponsored
health plans across the United States.
Valence also has a clinical integration
practice that works with non-risk-assuming
groups of doctors and hospitals, giving
them the tools to become an integrated
system and allowing them to collectively
negotiate enhanced reimbursements from
healthcare plans.
“Seven or eight years ago, the Federal Trade
Commission (FTC) said to doctors and hospitals,
‘You can’t collectively negotiate with
health plans unless you’re either assuming
financial risk or you’re clinically integrated’—
which they qualified as creating care
guidelines, collecting data, and measuring
performance against those guidelines,”
explained Stockard, who is now senior vice
president of financial and data management
services at Valence Health.
“We know that with the amount and
type of data that we have access
to, the sky is the limit for predictive
modeling, risk adjustment, and population-
based studies.”
—Todd Stockard, Cofounder, Senior Vice President, Financial and Data Management Services, Valence Health
“While the evidence-based guidelines are
out there, the challenge for these doctors
and hospitals is how to collect data from
disparate data sources to measure compliance
against those guidelines,” continued
Stockard. “The health plans won’t provide
it because it would be used to negotiate
against them. So we developed tools that
sit upon the billing systems in a given medical
community, pull the data out, and push
it to us on a daily, weekly, and monthly
basis. We also get data from labs, hospitals,
and ancillary providers to create a virtual
regional health information organization
(RHIO). We scrub it, link it, and apply
guidelines using data management and
analytical tools, then serve it back to the
individual doctors.
“The ROI for doctors is enormous,”
explained Stockard. “As result of being
clinically integrated through our process,
physicians have been able to negotiate rate
increases of between 15 and 20 percent
with health plans. Before, individual doctors
had no leverage in negotiations. In one
region, doctors were getting 110 percent
of Medicare prior to clinical integration.
Once they cleared the FTC hurdle and
negotiated together, they got 130 percent
of Medicare. Clinical integration facilitates
the assumption of financial risk, allows doctors
to compete for more market share, and
also provides patients with better access to
more informed care.”
Seeing Patients Across Providers
Essentially, Valence is providing the benefits
of an electronic medical record (EMR),
allowing independent practices to see what
is happening with a patient across providers.
Using a chronic sinusitis guideline as
an example, Stockard said, “If somebody
shows up in a primary care office three
times with that diagnosis, and the guideline
says they need an ear, nose, and throat
(ENT) referral and a CT scan, we now have
the data from everyone in town and can
look for that patient at the ENT encounter
or look at the radiologist data to see if the
CT scan happened.”
Additionally, Stockard pointed out that
Valence can now provide alerts about
patients before they visit a practice, so
doctors have the information they need to
ensure compliance with care guidelines.
For one client, Valence used analytics to
mine patient data to let doctors know which
children needed certain immunizations.
They provided doctors with a registry that
was integrated with an interactive voice
response (IVR) system to make outbound
calls to patients requiring immunization.
“We’ve turned our service from a retrospective
view to a proactive alert system
that contributes to keeping the population
healthy, versus only being able to see where
mistakes might have been made,” he said.
With the enactment of healthcare reform law
in the U.S., Stockard said it’s just back to the
future for Valence. “When we started, our
vision was that healthcare providers needed
to take control of their destiny,” he explained.
“Healthcare reform is saying the same thing
15 years later. The concept of accountable
care organizations (ACOs), and pushing more
accountability back to the providers, is what
our business model is all about.
“Providing this type of technology makes
Valence unique in the market,” he said.
“Others offer only registry-based products,
forcing practices to do manual chart extractions
and enter them into Web-based tools
and forms, with analysis done on patient
data samples. That amount of manual
work interferes with practice workflows
and requires a lot of administration time to
maintain FTC compliance.
“With Valence’s products and services, clients
need only log onto the site to look at
the data we have prepared. We have the
health plan management services that help
clients go from A to Z—become integrated
and ultimately become a health plan—while
providing access to state-of-the-art health
plan management technology. We are
focused on giving doctors access to critical
information at the right time.”
For Valence, that means collecting and
cleaning data for approximately 10,000 U.S.
doctors, at nearly 4,000 practices each day,
to provide information on the day’s patients
and measure doctors against 90 caregiving
guidelines.
“We know that with the amount and type
of data that we have access to, the sky
is the limit for predictive modeling, risk
adjustment, and population-based studies,”
mused Stockard. “We’re just starting to
scratch the surface in how we analyze data.
The next evolution for us will be benchmarking
relative to national norms and
population insight and what doctors can
anticipate relative to the population.”